RxPrep Infectious Diseases IV - Opportunistic Infections

opportunistic

infection that occurs when the immune system is weak and unable to respond normally to invading bacteria, fungi, viruses, and protozoa

HIV; <200

Immunocompromised states include diseases that destroy key components of the immune response, primarily ________ with a CD4 T lymphocyte count of ________ cells/mm^3.

≥2 weeks; ≥20; ≥2

Immunocompromised states include the use of systemic steroids for ________ at a prednisone dose of ________ mg/day or ________ mg/kg/day.

asplenia,

chemotherapy,

HIV,

immunosuppressant use,

severe neutropenia,

systemic steroid use

What are 6 examples of immunocompromised states?

asplenia

lack of a functioning spleen

<500

Severe neutropenia is defined as an ANC of ________ cells/mm^3.

PJP,

MAC,

Toxoplasmosis gondii encephalitis

What are 3 common opportunistic infections that require primary prophylaxis?

Pneumocystis jirovecii pneumonia

What does PJP stand for?

Mycobacterium avium complex

What does MAC stand for?

Candida

________ infections in the mouth/esophagus are more likely in immunocompromised states.

true

True or False: Primary prophylaxis for Candida infections is not usually recommended.

chemoprophylaxis

prevention of infection with antibiotics, antifungals, and/or antivirals

atovaquone,

dapsone,

pentamidine

What are 3 alternative drug options for PJP primary prophylaxis in HIV when the patient has a sulfa allergy?

atovaquone, pentamidine

What are 2 alternative drug options for PJP primary prophylaxis in HIV when the patient has a G6PD deficiency?

leucovorin

What drug is added to all pyrimethamine-containing primary prophylaxis regimens as rescue therapy to reduce the risk of pyrimethamine-induced myelosuppression?

<200

Patients with a CD4 count of ________ cells/mm^3 should start primary prophylaxis for PJP.

Bactrim DS QD

What is the preferred drug regimen for PJP primary prophylaxis in HIV?

atovaquone,

dapsone,

dapsone + leucovorin + pyrimethamine

What are 3 alternative drug regimens for PJP primary prophylaxis in HIV?

>200; >3 months

Patients can discontinue PJP primary prophylaxis when their CD4 count is ________ cells/mm^3 for ________ on antiretroviral therapy.

<100

Patients with a CD4 count of ________ cells/mm^3 should start primary prophylaxis for Toxoplasmosis gondii encephalitis.

Bactrim DS QD

What is the preferred drug regimen for Toxoplasmosis gondii encephalitis primary prophylaxis in HIV?

atovaquone,

dapsone + leucovorin + pyrimethamine

What are 2 alternative drug regimens for Toxoplasmosis gondii encephalitis primary prophylaxis in HIV?

<50

Patients with a CD4 count of ________ cells/mm^3 and not taking antiretroviral therapy should start primary prophylaxis for MAC.

azithromycin 1200 mg QW

What is the preferred drug regimen for MAC primary prophylaxis in HIV?

taking fully suppressive antiretroviral therapy

When can patients discontinue MAC primary prophylaxis?

secondary prophylaxis

prevention of reoccurrence of an infection

systemic

When treating thrush in patients with HIV, (localized/systemic) treatment is preferred.

fluconazole

What drug is preferred to treat oropharyngeal/esophageal candidiasis (thrush) in HIV?

itraconazole

What drug is an alternative treatment for oropharyngeal candidiasis (thrush) in HIV?

false

True or False: Secondary prophylaxis is recommended for thrush in patients with HIV.

amphotericin B (deoxycholate or liposomal) + flucytosine

What is the preferred drug regimen when treating Cryptococcal meningitis in patients with HIV?

fluconazole

What drug is an alternative treatment for Cryptococcal meningitis in patients with HIV?

ganciclovir, valganciclovir

What are 2 drug options for treating cytomegalovirus in patients with HIV?

cidofovir, foscarnet

What are 2 alternative drug options for treating cytomegalovirus in patients with HIV?

(azithromycin or clarithromycin) + ethambutol

What is the preferred drug regimen for treating MAC in patients with HIV?

Bactrim

What is the preferred drug when treating PJP in patients with HIV?

atovaquone,

pentamidine IV

What are 2 alternative drug options for treating PJP in patients with HIV?

cat feces/litter,

undercooked/raw meat

What are 2 risk factors for contracting Toxoplasmosis gondii encephalitis?

leucovorin + pyrimethamine + sulfadiazine

What is the preferred drug regimen for treating Toxoplasmosis gondii encephalitis in patients with HIV?

Bactrim

What is an alternative drug for treating Toxoplasmosis gondii encephalitis in patients with HIV?